| NPI | 1619286234 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: MO 2010033344) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: MO 2010033344) |
| 101YM0800X Counselor Mental Health (Licence: MO 2010033344) | |
| Enumeration Date | 2010-09-30 |
| Last Update Date | 2016-02-16 |